消化科就诊老年患者小肠细菌过度生长的临床特征及治疗初探

Clinical features and treatment of small intestinal bacterial overgrowth in elderly patients hospitalized in gastroenterology department

目的研究消化科就诊的老年患者小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)的发生率和临床特征,初步探讨药物治疗的疗效。方法纳入2016年9月-2019年6月于解放军总医院第二医学中心消化科门诊就诊及住院的60岁以上人群,应用乳果糖氢呼气试验(lactulose methane and hydrogen breath test,LBT)检测SIBO发生率并分析SIBO患者的临床特征及LBT特点。选择双歧杆菌三联活菌胶囊(420 mg,3次/d)联合地衣芽孢杆菌活菌胶囊(0.5 g,3次/d)、利福昔明片(0.4 g,3次/d)或甲硝唑片(0.4 g,3次/d)对SIBO患者进行2周治疗,比较治疗前、后患者临床症状和LBT变化。结果共纳入272例老年LBT受试者,SIBO发生率为62.50%(170/272)。老年SIBO的常见症状有排气多、腹胀、肠鸣、嗳气、腹痛、便不尽、粪便干结等。SIBO阳性组小肠段和结肠段呼气中氢气、甲烷丰度明显高于SIBO阴性组(P<0.05)。Logistic多因素分析显示,腹部手术史是老年SIBO的独立危险因素。86例接受治疗,症状改善率为65.12%(56/86)。治疗后患者腹痛、腹胀、嗳气、排气多、肠鸣、排便增多、便急、便不尽、口腔异味、粪便干结状况较治疗前明显好转,但溏便症状改善不明显。治疗后LBT转阴率为43.02%(37/86)。治疗后各时间点呼气氢气丰度均下降,结肠段(120 min时)更为明显[(67.77±52.26)×10^-6 vs (46.94±55.19)×10^-6,P<0.05];各时间点呼气中甲烷丰度亦有下降,小肠段(80 min时)更为明显[(17.85±23.65)×10^-6 vs (12.48±11.42)×10^-6,P<0.05]。结论老年SIBO发生率约为62.50%。药物治疗可以改善SIBO患者的消化道症状,降低呼气中氢气与甲烷丰度。

Objective To investigate the prevalence and clinical features of small intestinal bacterial overgrowth (SIBO) in elderly patients hospitalized in gastroenterology department,and study the effect of drug therapy.Methods Patients over 60 years old hospitalized in the department of gastroenterology of the second medical center in Chinese PLA General Hospital were enrolled from September 2016 to June 2019.A11 patients had undergone lactulose breath test (LBT) to detect the prevalence of SIBO.The clinical and LBT features of SIBO were analyzed.The effects of bifidobacterium triple viable capsules (420 mg,thrice per day) with bacillus licheniformis capsule (0.5 g,thrice per day),rifaximin tablet (0.4 g,thrice per day) or metronidazole tablet (0.4 g,thrice per day) for 2 weeks on SIBO were evaluated by comparing changes in clinical features and LBT results after treatment.Results Totally 272 patients were enrolled in our study,and the prevalence of SIBO was 62.50% (170/272).Common symptoms of SIBO included increased flatus,abdominal distension,borborygmus,belching,bad breath,abdominal pain,fecal urgency,incomplete evacuation,hard stool,etc.The breath hydrogen and methane concentrations in SIBO positive group were significantly higher than those of SIBO negative group (P<0.05).Multivariate logistic regression analysis showed that abdominal surgery history was an independent risk factor for SIBO.Totally 86 patients received drug therapy,and the symptom improvement rate was 65.12% (56/86).After treatment,the symptoms of abdominal pain,abdominal bloating,belching,increased flatus,borborygmus,defecation increase,fecal urgency,incomplete evacuation,bad breath and hard stool significantly improved (P<0.05);however,the symptom of loose stool did not changed (P>0.05).After treatment,43.02% (37/86) of SIBO patients presented negative LBT results with lower hydrogen concentration at all time points,especially at 120 min ([67.77±52.26]×10^-6 vs [46.94±55.19]×10^-6,P<0.05),and lower methane concentration especially at 80 min ([17.85±23.65]×10^-6 vs [12.48±11.42]×10^-6,P<0.05).Conclusion The prevalence of SIBO in the elderly is 62.50%.History of abdominal surgery is an independent risk factor for SIBO.Drug therapy can improve the symptoms of elderly SIBO patients,and reduce the concentration of hydrogen and methane in breath.